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Opinion

Skin cancer patients shouldn’t have to pay to improve their survival prospects

By Neil Day, CEO of Skin Analytics

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Winter is only just upon us, yet the NHS waiting list in England already stands at a record 7.7m people with some reports suggesting the hidden waiting list is over 20m.

Our health service is buckling under the strain, and the coming months will offer little respite for beleaguered clinicians.

The extent of the current crisis is laid bare by the Government’s most recent intervention, which affords anyone waiting more than 40 weeks the chance to be seen elsewhere in England.

No one should be left waiting this long, let alone forced to travel to a different part of the country simply to receive a consultation. And yet here we are.

It’s therefore no surprise that, despite the protracted cost-of-living crisis eating away at household incomes, more patients than ever are opting to bypass the NHS and pay for private consultations.

The Care Quality Commission has rightly voiced concerns over this trend – that patients are being forced into a two-tier system, with those who can afford to pay able to receive priority treatment and better outcomes.

It has also warned that patients are pushing themselves into debt to access healthcare.

For many suspected skin cancer patients, the situation looks deeply concerning.

With over 16,700 new diagnoses every year, melanoma is the fifth most common cancer in the UK and accounts for the highest number of urgent referrals.

However, data suggests that Stage 1 melanoma diagnosis rates have dropped from over 91% in 2014 to 87 per cent in 2021.

This will likely fall further as the estimated ~2500 patients with melanoma not diagnosed during the COVID-19 pandemic present with late-stage disease.

Somewhere between a quarter and a third of melanoma and non-melanoma patients are not currently found on urgent suspected cancer pathways.

Survival rates improve markedly with early diagnosis and treatment, yet only 35 per cent of NHS trusts are seeing these patients within 14 days.

One in 10 patients will wait longer than four weeks to be seen.

And the UK is facing a growing shortage of dermatologists and an imbalance in overall coverage, leading to regional ‘dermatology deserts’.

In line with the overarching trend, we’re seeing more and more patients with suspicious skin lesions opting to visit private dermatologists rather than holding out hope for an NHS appointment.

Their rationale is obvious: if there’s a paid option to be seen sooner, why take the risk and go on waiting for the free service?

Patients want AI technology to solve this problem

Despite sustained and considerable effort from dermatology departments, NHS skin cancer diagnostic services are failing to deliver, forcing people to opt for paid alternatives regardless of whether they can afford them.

Given that waiting lists are unlikely to improve in the near future, the two-tier healthcare system will become increasingly pronounced unless there is a radical change in diagnostic approach.

Artificial Intelligence (AI) has long been suggested as a part of the solution, and over the past three years, the technology has started to deliver impressive results.

Leading AI diagnostic tools are already correctly identifying over 95 per cent of skin cancers while discharging more than 7 in 10 benign lesions.

This is incredibly reassuring when we consider that survival rates for skin cancer soar above 95 per cent if detected early. It also reduces anxieties for those patients with benign cases waiting to be seen.

Once patients know that an AI assessment is an option to speed up their access, they’re receptive to it.

Our research, based on real-world patient experiences, shows that 62 per cent of NHS patients with suspected skin cancer would rather have their skin assessed by a computer than wait weeks to see a dermatologist in-person.

More than two-thirds (68 per cent) of those who experienced the AI-led assessment said the lack of face-to-face interaction with a doctor didn’t negatively impact the experience.

Work is needed to convince clinicians

Clearly, patients are on board with the use of AI for skin cancer screening, assessment and triage, recognising its potential to expedite and improve the accuracy of the diagnostic process.

However, adopting this technology is not without its challenges, particularly when it comes to clinician acceptance and integration into existing healthcare systems.

Clinicians, who are integral to the implementation of any new medical technology, have been quick to express their reservations about AI assessment – whether that’s the reliability of AI decisions, the potential for reduced patient-clinician interaction, or simply the implications for their professional roles.

In particular, there is apprehension regarding the accountability of AI systems, especially in cases of misdiagnosis or missed diagnosis.

Clinicians are also wary of becoming overly reliant on technology, potentially at the cost of their clinical judgement and expertise.

Furthermore, integrating AI into existing clinical workflows raises logistical and training challenges.

Healthcare professionals need to be adequately trained in how to use these AI tools and in understanding their limitations and interpreting their findings.

Achieving this requires time and resources, which can be a barrier in an already stretched healthcare system.

All of this points to the need for a deep collaboration built on trust. Clinicians are right to be sceptical as there are vastly different quality of AI solutions out there.

But we must get our clinical teams to move past scepticism in the light of quality evidence and start to engage with AI solutions.

There must be a collaborative approach involving policymakers, healthcare providers, and technology developers.

This approach should focus on transparently showcasing the efficacy of AI tools through clinical trials and real-world studies, providing robust training for healthcare professionals, and ensuring a clear framework for accountability and governance.

Restoring equity to skin cancer diagnosis

Embracing AI is not just about adopting a new tool; it’s about revolutionising our approach to skin cancer diagnostics in a way that alleviates pressure on the NHS and reassures patients that paid private healthcare is not the only avenue towards a speedy diagnosis.

By addressing the concerns of clinicians and ensuring a smooth integration into healthcare systems, AI can be a powerful ally in the fight against skin cancer, offering hope for faster, more accurate diagnoses and, ultimately, improved patient outcomes.

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